Tackling emergency-room issues not a simple solution, doctor says

By Russ Britt

Making a dent in health-care costs by targeting an overabundance of emergency-room visits may be the right prognosis, but some of the solutions are misguided, a Rand Corp. researcher says.

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Dr. Art Kellermann, a former emergency-room physician, says putting higher co-pays on ER visits, turning patients away from such facilities or cutting ER resources isn’t the solution. Yes, more primary care is needed to avoid ER visits, but more resources should go toward the emergency room because it is a critical link in the health-cost spectrum, he says.

“Often the only light on for health-care after business hours is the emergency room,” he said.

Kellermann backs up his comments with a study that he and several fellow researchers from Rand published Monday, which says that four out of five ER visits are the result of a doctor’s directive.

Studying ER practices from 2003 to 2009, the report says that 2.7 million more hospital admissions were the result of an emergency-room physician’s prognosis at the end of that time frame than at the beginning. Further, there were 1.6 million fewer hospital admissions from outside doctors from 2003 to 2009.

And by the end of those six years, ER doctors accounted for half of all hospital admissions, up from 43%, and 70% of all Medicare patients. That means that 4% of all doctors are making the bulk of decisions on issues that have a massive impact on health-care economics by determining who will receive pricey hospital care.

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